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- Typically characterized by bilateral mild to moderate pain or pressure without other associated symptoms
- Three types of tension-type headache (TTH):
- Infrequent episodic TTH: <1 day per month
- Frequent episodic TTH: ≥1 but <15 days per month
- Chronic TTH: ≥15 days per month for >3 months
- TTHs replaced older terms: muscle contraction headache, stress or tension headache, and psychogenic headache
The most common type of primary headachePrevalence
- Peak age of prevalence in the United States: the 4th decade
- Lifetime prevalence: men (69%); women (88%)
- Prevalence of episodic TTH decreases with age, whereas the prevalence of chronic TTH increases with age.
Etiology and Pathophysiology
- Debatable: peripheral and/or central mechanisms
- Activation of peripheral nociceptors leads to myofascial pain in episodic TTH.
- Prolonged stimulation of nociceptors sensitizes the central pain pathways leading to chronic TTH.
- Nitric oxide may play an important role in TTH.
An increased genetic risk has been suggested by studies, particularly for chronic TTH.
Associated with triggers/precipitating factors:
- Stress (mental or physical): the most common
- Change in sleep regimen
- Skipping meals
- Certain foods (caffeine, alcohol, chocolate)
- Physical exertion
- Environmental factors (sun glare, odors, smoke, noise, lighting)
- Poor or sustained posture
- Female hormonal changes
- Medications (e.g., nitrates, SSRIs, antihypertensives)
- Overuse of abortive headache medication
- Identify and avoid triggers/precipitating factors.
- Minimize physical and emotional stress.
- Encourage relaxation techniques: biofeedback, relaxation therapy, and physical therapy.
- Consider counseling/psychotherapy.
Commonly Associated Conditions
- 83% of patients with migraine headaches also suffer from TTHs.
- Debatable: increased prevalence of comorbid anxiety and depression